This is a very common question for families needing orthodontic treatment is: Does Medicaid pay for braces? The short answer: Yes, but only in certain situations.
Medicaid will usually pay for braces when they are considered medically necessary, not when they are requested only for cosmetic reasons. Coverage rules depend on age, medical need, and the state where you live.
Common types of braces that
Medicaid coverage includes:
- Traditional Metal Braces: These are the most commonly covered option because they are effective and affordable.
- Clear or Ceramic Braces: Usually not covered unless there is a special medical reason.
- Retainers and Follow-Up Care: Often included when braces are approved, since they are part of necessary orthodontic treatment.
Understanding these basics can help you know what to expect before starting the process.
When Does Medicaid Cover Braces?
Whether Medicaid will pay depends largely on the patient’s age and the severity of the dental problem.
Does Medicaid Pay for Braces for Children?
Yes. In most states, the answer to does Medicaid pay for braces for children is yes, when braces are medically necessary. Federal Medicaid rules require dental and orthodontic care for children under 21 through the EPSDT program.
Braces are typically approved for children who have serious issues such as:
- Severe overbites or underbites
- Problems chewing or speaking
- Jaw misalignment
- Crowded or impacted teeth
- Facial deformities or injury
If a dentist or orthodontist proves that braces are needed to correct a health problem, Medicaid will usually cover them.
Does Medicaid Pay for Braces for Adults?
For adults, coverage is much more limited. Most states do not provide orthodontic benefits for adults unless there is a major medical condition, surgery requirement, or trauma-related need.
So if you are an adult asking does Medicaid pay for braces, the answer is usually no, unless there is a documented medical necessity beyond cosmetic improvement.
>>>>Read more: Does Medicaid Cover Braces? Kids, Adults & Approval
Who Qualifies for Free Braces?
Many parents and patients also ask: Who can actually qualify to get braces at no cost through Medicaid?
Medicaid Eligibility Requirements
Before braces can be covered, the patient must first qualify for Medicaid. Eligibility is based on:
- Household income
- Family size
- Age
- Disability status (in some cases)
Without active Medicaid enrollment, orthodontic treatment will not be paid for.
Medical Necessity vs. Cosmetic Braces
This is the most important factor. Medicaid does not pay for braces simply to make teeth look straighter. Treatment must be proven medically necessary.
Orthodontists usually perform an evaluation and assign a severity score. Only patients who meet the required threshold are approved. Mild crooked teeth or small gaps generally do not qualify.
Income and Age Qualifications
Children from low-income households who meet state Medicaid guidelines have the best chance of approval. Adults, even if income-qualified, often face stricter rules or no orthodontic benefits at all.
How Do You Get Braces if You Don’t Have Money?
If Medicaid will not cover braces, there are still several options available.
Medicaid and CHIP Dental Programs
Children who do not qualify for Medicaid may qualify for CHIP (Children’s Health Insurance Program). In some states, CHIP also helps pay for orthodontic treatment when medically necessary.
Low-Cost Orthodontic Clinics
Dental schools and community clinics often provide braces at a reduced cost. Treatment is performed by supervised dental students and can be far cheaper than that of private orthodontists.
Payment Plans and Financial Assistance
Many orthodontic offices offer:
- Monthly payment plans
- Sliding-scale fees
- Discounts for low-income families
These options can make braces more affordable even without Medicaid coverage.
>>>>Read more: Does Medicaid Cover Dental Implants? Rules & Eligibility
Medicaid Braces Coverage by State
One important thing to remember is that Medicaid is managed by each state. That means the exact answer to does Medicaid pay for braces can be different depending on where you live.
Some states have very strong orthodontic benefits for children, while others have stricter approval rules. A few states offer limited adult orthodontic coverage, but many do not.
To find accurate information, you should:
- Contact your state Medicaid office
- Ask a local orthodontist who accepts Medicaid
- Review your state’s Medicaid dental handbook
- Knowing your state’s specific guidelines can save time and frustration.
How to Apply for Braces Through Medicaid
If you believe braces may be covered, follow these general steps:
- Confirm that the child or patient is enrolled in Medicaid
- Find an orthodontist who accepts Medicaid
- Schedule an orthodontic evaluation
- Complete X-rays and exams
- Have the orthodontist submit a prior authorization request
- Wait for Medicaid approval before treatment begins
Treatment should not start until Medicaid has officially approved the case.
What to Do if Medicaid Won’t Pay for Braces
If you receive a denial, don’t panic. You still have options:
- Ask the orthodontist to submit additional medical documentation
- Request a formal appeal through Medicaid
- Seek a second opinion from another provider
- Look into low-cost clinics or payment plans
A denial for “does Medicaid pay for braces” does not always mean the final answer is no.
Common Questions About Medicaid and Braces
Does Medicaid Cover Braces for Overbites or Crooked Teeth?
Medicaid may cover braces for overbites or severely crooked teeth if they cause functional problems like difficulty chewing, jaw pain, or speech issues. Mild cases are usually considered cosmetic and not covered.
How Long Does Approval for Braces Take?
Approval can take anywhere from a few weeks to a few months. The timeline depends on your state Medicaid office and how complete the orthodontist’s paperwork is.
Can You Choose Your Own Orthodontist?
You must use an orthodontist who accepts Medicaid. Not all providers participate, so it’s important to verify this before scheduling an appointment.
Conclusion: Options for Getting Affordable Braces
So, does Medicaid pay for braces? Yes, primarily for children and only when braces are medically necessary.
Medicaid can be a valuable resource for families who cannot afford orthodontic care, but approval depends on strict guidelines. Adults usually have fewer options, but alternative programs and payment plans can still help make treatment possible.
If you think you or your child may qualify, the best first step is to schedule an evaluation with a Medicaid-approved orthodontist. With the right information and persistence, getting affordable braces is possible.
